ABSTRACT
Background. GeneXpert MTB/RIF is useful for the diagnosis of pulmonary TB in adults, but there is limited evidence on its usefulness in extrapulmonary TB.Objectives. To investigate the diagnostic accuracy of GeneXpert MTB/RIF in HIV-infected and HIV-uninfected patients with suspected musculoskeletal TB.Methods. A prospective study of patients with suspected musculoskeletal (bone and joint) TB was undertaken. The diagnostic accuracy of GeneXpert MTB/RIF was compared with the reference standards of culture and histopathology.Results. A total of 206 biopsies from 201 patients (23% HIV-infected) were evaluated. The sensitivity and specificity of GeneXpert MTB/RIF was 92.3% (84/91) and 99.1% (114/115), respectively. GeneXpert MTB/RIF detected 8.8% more cases than culture (84/91 (92.3%) v. 76/91 (83.5%), respectively; p=0.069). GeneXpert MTB/RIF also detected all 4 multidrug-resistant TB cases and an additional 2 rifampicin-resistant cases in culture-negative samples. The sensitivity of GeneXpert MTB/RIF in HIV-infected patients was 96.9% (31/32) v. 89.6% (43/48) in HIV-uninfected patients (p=0.225).Conclusion. GeneXpert MTB/RIF is an accurate test for the detection of TB in tissue samples of HIV-infected and HIV-uninfected patients with suspected musculoskeletal TB. A positive GeneXpert MTB/RIF result should be regarded as microbiological confirmation of TB
Subject(s)
Data Accuracy , HIV Infections , Musculoskeletal Diseases , Rifampin , South Africa , Tissue Array Analysis , Tuberculosis, PulmonaryABSTRACT
The Acute Spinal Injury Unit; relocated from Conradie Hospital to Groote Schuur Hospital in mid-2003; admitted 162 patients in the first year of its existence. A large number of these injuries were the result of interpersonal violence; particularly gunshot wounds. Aim. To review patients with gunshot injuries to the spine; with reference to neurological injury; associated injuries; need for surgery and complications. Methods. A comprehensive database is maintained to collect data on all spinal injury admissions. These data; as well as case notes and X-rays; were reviewed for all gunshot spine patients admitted to the Acute Spinal Injury Unit over a year. Forty-nine patients were identified. Thirty-eight were male and 11 female with an average age of 27.5 years (range 15 - 51 + 8.53). The average stay in the acute unit was 30 (4 - 109 + 28) days. Results. The spinal injury was complete in 38 and incomplete in 8; with 3 having no neurological deficit. The level was cervical in 13; thoracic in 24 and lumbar in 12. Only 9 patients improved neurologically. The spine was considered stable in 43 cases. Stabilisation was performed in the 6 unstable cases. The bullets were removed in 11 cases as they were in the canal. There were 55 significant associated injuries; viz. 14 haemo-pneumothoraces; 16 abdominal visceral injuries; 3 vascular injuries; 4 injuries of the brachial plexus and 3 of the oesophagus; 2 tracheal injuries; 1 soft palate injury and 11 non-spinal fractures. Complications included 3 deaths and discitis in 3 cases; pneumonia in 6 and pressure sores in 6. Conclusion. Gunshot injuries of the spine are a prevalent and resource-intensive cause of paralysis. There is a high incidence of permanent severe neurological deficit; but usually the spine remains mechanically stable. Most of the management revolves around the associated injuries and consequences of the neurological deficit